4.6 Article

Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia

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BLOOD ADVANCES
卷 6, 期 1, 页码 339-357

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ELSEVIER
DOI: 10.1182/bloodadvances.2021004916

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资金

  1. National Cancer Institute [U24CA076518, R01CA215134]
  2. National Heart, Lung, and Blood Institute [R01HL130388, UG1HL06924]
  3. National Insti-tute of Allergy and Infectious Diseases [R01AI128775]
  4. Health Resources and Services Administration [HHSH250201700006C, HHSH250201700007C]
  5. Office of Naval Research [N00014-20-1-2705, N00014-20-1-2832]
  6. Biomedical Advanced Research and Development Authority
  7. Actinium Pharmaceuticals
  8. Adienne
  9. Allovir
  10. Amgen
  11. Angiocrine Bio-science
  12. Astellas Pharma
  13. bluebird bio
  14. Boston Children's Hospital
  15. Bristol Myers Squibb
  16. Be the Match Foundation
  17. Celgene
  18. CSL Behring
  19. CytoSen Therapeutics
  20. Daiichi Sankyo
  21. Dana-Farber Cancer Institute
  22. ExcellThera
  23. Fate Therapeutics
  24. Gamida-Cell
  25. Genentech
  26. Incyte
  27. Janssen/Johnson Johnson
  28. Jazz Pharmaceuticals
  29. Kiadis Pharma
  30. Kite Pharma
  31. Kyowa Kirin
  32. Legend Biotech
  33. Magenta Thera-peutics
  34. Medical College of Wisconsin
  35. Merck Sharp Dohme
  36. Millen-nium Pharmaceuticals
  37. Miltenyi Biotec
  38. National Marrow Donor Program
  39. Novartis Pharmaceuticals
  40. Omeros
  41. OncoImmune
  42. Orca Bio-systems
  43. Pfizer
  44. Pharmacyclics
  45. Sanofi Genzyme
  46. St. Baldrick's Foun-dation
  47. Stanford University
  48. Stemcyte
  49. Takeda Oncology
  50. Takeda Pharma
  51. Vor Biopharma
  52. Xenikos

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This study compared the outcomes of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) with other HCT approaches for acute lymphoblastic leukemia (ALL) patients. The results showed that haploidentical HCT using PTCy had similar overall survival (OS) but lower incidence of chronic graft-versus-host disease (cGVHD) compared to traditional matched sibling and unrelated donor HCT methods, making it a preferred alternative donor option for ALL patients in complete remission.
The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLAmatched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilical cord blood (UCB) HCT. Comparing haploidentical HCT to MSD HCT, we found that OS, leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and acute graft-versus-host disease (aGVHD) were not different but chronic GVHD (cGVHD) was higher in MSD HCT. Compared with MUD HCT, OS, LFS, and relapse were not different, but MUD HCT had increased NRM (hazard ratio [HR], 1.42; P = .02), grade 3 to 4 aGVHD (HR, 1.59; P = .005), and cGVHD. Compared with 7/8 UD HCT, LFS and relapse were not different, but 7/8 UD HCT had worse OS (HR, 1.38; P = .01) and increased NRM (HR, 2.13; P <_ .001), grade 3 to 4 aGVHD (HR, 1.86; P = .003), and cGVHD (HR, 1.72; P <_ .001). Compared with UCB HCT, late OS, late LFS, relapse, and cGVHD were not different but UCB HCT had worse early OS (<_18 months; HR, 1.93; P < .001), worse early LFS (HR, 1.40; P = .007) and increased incidences of NRM (HR, 2.08; P < .001) and grade 3 to 4 aGVHD (HR, 1.97; P < .001). Haploidentical HCT using PTCy showed no difference in survival but less GVHD compared with traditional MSD and MUD HCT and is the preferred alternative donor HCT option for adults with ALL in complete remission.

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